by k3llyadm1n | Nov 27, 2019 | Coding Updates
2015 Arthrocentesis Injection coding updates
Starting January 1, 2015 all providers will need to properly report Arthrocentesis procedures dependent if the procedure was performed with or without ultrasound guidance.
Without Ultrasound Guidance:
Starting January 1, 2015, CPT codes 20600, 20605, or 20610 have been revised to describe Arthrocentesis procedures performed without ultrasound guidance.
v20600: Arthrocentesis, aspiration and /or injection, small joint or bursa (eg, fingers; toes); without ultrasound guidance, with permanent recording and reporting.
v20605: Arthrocentesis, aspiration and /or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, writs, elbow or ankle, olecranon bursa;); without ultrasound guidance, with permanent recording and reporting.
v20610: Arthrocentesis, aspiration and /or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance, with permanent recording and reporting.
With Ultrasound Guidance:
Starting January 1, 2015, CPT 20604, 20606, or 20611 have been created to report Arthrocentesis procedures perform with ultrasound guidance.
v20604: Arthrocentesis, aspiration and /or injection, small joint or bursa (eg, fingers; toes); with ultrasound guidance, with permanent recording and reporting.
v20606: Arthrocentesis, aspiration and /or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, writs, elbow or ankle, olecranon bursa;); with ultrasound guidance, with permanent recording and reporting.
v20611: Arthrocentesis, aspiration and /or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting
Steps for proper coding:
vDetermine the size of the joint.
vReview the description to determine if imaging is used.
vReport 20604, 20606, or 20611 if performed with ultrasound guidance
vIf fluoroscopic, CT, or MRI guidance is used report 20600, 20605, 20610 for the surgical procedure and see 77002, 77012, and 77021 to report imagining guidance separately.
As always, my staff will be available to assist you with any questions are concerns you may have.
by k3llyadm1n | Nov 27, 2019 | Coding Updates
Physical Therapy Evaluation (97001) and Physical Therapy Re-evaluation (97002) codes have been deleted for 2017 and replaced with four new codes.
The new evaluation codes 97161-97163 describe services that range in complexity from low to high and have a code descriptor that has specific required components. I have cited some of these requirements below from the new AMA 2017 CPT codebook however I do recommend that you review it as well.
#•97161 Physical therapy evaluation: low complexity, requiring these components:
• A history with no personal factors and/or comorbidities that impact the plan of care;
• An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions;
• A clinical presentation with stable and/or uncomplicated characteristics; and
• Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.
Typically, 20 minutes are spent face-to-face with the patient and/or family.
#•97162 Physical therapy evaluation: moderate complexity, requiring these components:
• A history of present problems with 1-2 personal factors and/or comorbidities that impact the plan of care;
• An examination of body system(s) using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions;
• An evolving clinical presentation with changing characteristics; and
• Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.
Typically, 30 minutes are spent face-to-face with he patient and/or family.
#•97163 Physical therapy evaluation: high complexity, requiring these components:
• A history of present problems with 3 or more personal factors and/or comorbidities that impact the plan of care;
• An examination of body system(s) using standardized tests and measures in addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions;
• An clinical presentation with unstable and unpredictable characteristics; and
• Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.
Typically, 45 minutes are spent face-to-face with the patient and/or family.
For re-evaluation of physical therapy established plans of care, you would now utilize CPT 97164.
#•97164 Re-evaluation of physical therapy established plan of care, requiring these components:
• An examination including a review of history and use of standardized tests and measures is required; and
• Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome.
Typically, 20 minutes are spent face-to-face with the patient and/or family.
by k3llyadm1n | Nov 27, 2019 | Commercial Insurances
Beginning with dates of service 08/01/2014, claims for in-office radiology services should be sent directly to Cigna, using the address on the back of your patient’s Cigna ID Card, or electronically using payer ID 62308. Historically these claims have been sent to MedSolutions.
If you have any questions about these changes, you can contact Cgina Customer Services at (800) 882-4462
by k3llyadm1n | Nov 27, 2019 | Medicare
What are the Functional Limitation G- Codes?
Beginning on January 1, 2013 in a testing phase and required as of July 1, 2013, therapists are required to report new G-Codes to report the functional limitation of their patients. This new set of G-Codes will move therapists closer to incorporating function and functional progress with treatments. There are a total of 42 new non-payable G-Codes and 7 new modifiers for use on claims for Physical Therapy, Occupational Therapy, and Speech-Language Pathology services.
**Beginning July 1, 2013, Medicare will begin returning and rejecting claims for therapy services that do not contain the required functional G-Code information.**
Required Reporting of Functional G-Codes and Severity Modifiers
The functional G-Codes and corresponding severity modifiers are used in the required reporting on specified therapy claims for certain Dates of Service. Only one functional limitation shall be reported at a given time for each related therapy plan of care.
Functional reporting is required on therapy claims as shown below:
- At the outset of a therapy episode of care (initial date of service).
- At least once every 10 treatment days.
- The same Date of Service that an evaluative procedure is submitted (Codes 97001, 97002, 97003, 94004)
- At the time of discharge from the therapy episode of care
- On the same Date of Service the reporting of a particular limitation is ended, in cases where the need for further therapy is needed
What are the Functional Limitation G-Codes?Below are some of the functional limitation G-Codes that are to be used by Physical Therapists. They are organized in related sets. Please note: this is not a complete list. Mobility Set
- G8978 -Mobility: walking and moving around functional limitation, current status, at episode outset and reporting intervals
- G8979 – Mobility: walking and moving around functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
- G8980 – Mobility: walking and moving around functional limitation, discharge status, at discharge from therapy or to end reporting
Changing and Maintaining Body Position Set
- G8981 – Changing and Maintaining Body Position functional limitation, current status, at episode outset and at reporting intervals
- G8982 – Changing and Maintaining Body Position functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
- G8983 – Changing and Maintaining Body Position functional limitation, discharge status, at discharge or to end reporting
Carrying, Moving and Handling Objects Set
- G8984 – Carrying, Moving and Handling Objects functional limitation, current status, at episode outset and at reporting intervals
- G8985 – Carrying, Moving and Handling Objects functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
- G8986 – Carrying, Moving and Handling Objects functional limitation, discharge status, at discharge or to end reporting.
Self Care Set
- G8987 – Self Care functional limitation, current status, at episode outset and at reporting intervals
- G8988 – Self Care functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
- G8989 – Self Care functional limitation, discharge status, at discharge or to end reporting.
Other PT/OT Primary Set
- G8990 – Other PT/OT Primary functional limitation, current status, at episode outset and at reporting intervals
- G8991 – Other PT/OT Primary functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
- G8992 – Other PT/OT Primary functional limitation, discharge status, at discharge or to end reporting.
Other PT/OT Subsequent Set
- G8993 – Other PT/OT Subsequent functional limitation, current status, at episode outset and at reporting intervals
- G8994 – Other PT/OT Subsequent functional limitation, projected goal status, at episode outset, at reporting intervals, and at discharge or to end reporting
- G8995 – Other PT/OT Subsequent functional limitation, discharge status, at discharge or to end reporting.
Severity/Complexity ModifiersFor each non-payable G-Code used, a modifier must be used to report the severity/complexity for that functional measure. The severity modifiers reflect the patient’s percentage of functional impairment as determined by the therapist furnishing the therapy services. The seven modifiers include:.
- CH – 0 % impaired, limited or restricted
- CI – At least 1 % but less than 20 % impaired, limited, or restricted
- CJ – At least 20 % but less than 40 % impaired, limited, or restricted
- CK – At least 40 % but less than 60 %impaired, limited, or restricted
- CL – At least 60 % but less than 80 %impaired, limited, or restricted
- CM – At least 80 %but less than 100 % impaired, limited, or restricted
- CN – 100 % impaired, limited, or restricted
